During our last two infectious-disease crises — the Ebola epidemic in 2014 and the Zika outbreak in 2015 and 2016 — Donald Trump’s xenophobic, divisive and antiscience instincts were on display to horrible effect. As Obama mustered a response to Ebola in West Africa — to save lives and to contain the disease — Trump repeatedly tweeted that the United States should cut off overseas response efforts, decline treatment to an American evangelical doctor who had contracted the disease, and reject standard scientific protocols.

During the Zika outbreak, an apathetic Trump backed anti-immigrant lawmakers who delayed funding for a federal response — leading to the first-ever cases of the disease being contracted in the United States. And after Trump’s election, he met with antivaccine activists — building on a history of tweets that baselessly tied autism to vaccination rates.

While President Trump’s key early appointees in this area — Health and Human Services Secretary Tom Price and CDC director Brenda Fitzgerald — departed from the president’s worst instincts on pandemic prevention, both were felled by ethical issues. Trump himself has been mum on the flu; it appears to be the one of the few topics in public life on which he has nothing to say. America will get through this year’s epidemic without him, but what about the major threat that looms on the horizon: a deadly pandemic flu? Here, Trump’s terrible instincts and attitudes could be catastrophic.

How bad could such a pandemic be? 2018 marks the 100th anniversary of the 1918 Spanish flu, which killed more than 600,000 Americans — more than World Wars I and II combined. Doctors today have more tools to combat such an outbreak, but our increased interconnectedness means we face a greater threat of rapid spread than we did a century ago. As a result, modern science will do less to protect us from a flu pandemic than most people suspect.

Our best defense against such a pandemic reaching our shores is an investment in global health security: stopping diseases overseas. But the Trump administration has undertaken a stunning reversal of 16 years of progress under President George W. Bush and Obama. The massive government funding bill approved in mid-February slashed funds for the CDC’s Prevention and Public Health Fund.

Team Trump recently announced deep cuts to global health funding rooted in the Ebola epidemic, implementing an 80 percent reduction in the global reach to detect infectious-disease outbreaks abroad. Trump’s newly released budget proposal would wreak more havoc by cutting another $1 billion from the CDC.

Such an “America First” mind-set toward health security is dangerous. Disengaging from the world not only turns our back on humanitarian needs abroad — it also increases the risk that those crises will reach our shores. Because of rapid international travel, an outbreak in a remote village in China or a forest in Africa can lead to disease transmission in a U.S. urban center within 24 hours, and in any town in our country hours later. Before we even know the threat has arrived, our emergency rooms could be overwhelmed. And no, MAGA Nation, a giant wall along our southern border will not protect us.

February 11, 2018

The Ghana Health Services (GHS) has cautioned all Divisional Directors, Regional Deputy Directors of the Service and public health care facilities of the likelihood of outbreaks of Lassa fever in the country.

The GHS in a release explained the disease has already affected several countries in West Africa with over 300 cases and 31 deaths in Nigeria and this has necessitated urgent spontaneous national response actions among all neighboring countries.

The GHS recommend the following to all health workers and institutions:

1. Surveillance on Lassa fever and Acute Haemorrhagic Fevers in general (using case definitions) should be enhanced.

2. Suspected cases of Lassa fever should be managed in specific isolation conditions

3. Health workers should adhere to regular Infection Prevention and Control (IPC) measures to prevent and protect against possible nosocomial transmission

4. Blood sample from suspected case(s) should be taken and safely packaged and sent to Noguchi Memorial Institute for Medical Research (NMIMR) for laboratory investigations

5. All levels (National, Regions, Districts and Facilities) are requested to update their preparedness and response plans for Lassa fever and VHF in general, sensitize the respective staff and create necessary public awareness.

Prevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. The Zika Contraception Access Network (Z-CAN) aimed to build a network of health-care providers offering client-centred contraceptive counselling and the full range of reversible contraception at no cost to women in Puerto Rico who chose to prevent pregnancy during the 2016–17 Zika virus outbreak. Here, we describe the Z-CAN programme design, implementation activities, and baseline characteristics of the first 21 124 participants.

Methods

Z-CAN was developed by establishing partnerships between federal agencies, territorial health agencies, private corporations, and domestic philanthropic and non-profit organisations in the continental USA and Puerto Rico. Private donations to the National Foundation for the Centers for Disease Control and Prevention (CDCF) secured a supply of reversible contraceptive methods (including long-acting reversible contraception), made available to non-sterilised women of reproductive age at no cost through provider reimbursements and infrastructure supported by the CDCF.

To build capacity in contraception service provision, doctors and clinic staff from all public health regions and nearly all municipalities in Puerto Rico were recruited into the programme. All providers completed 1 day of comprehensive training in contraception knowledge, counselling, and initiation and management, including the insertion and removal of long-acting reversible contraceptives (LARCs).

Z-CAN was announced through health-care providers, word of mouth, and a health education campaign. Descriptive characteristics of programme providers and participants were recorded, and we estimated the factors associated with choosing and receiving a LARC method.

As part of a Z-CAN programme monitoring plan, participants were invited to complete a patient satisfaction survey about whether they had obtained free, same-day access to their chosen contraceptive method after receiving comprehensive counselling, their perception of the quality of care they had received, and their satisfaction with their chosen method and services.

Findings

Between May 4, 2016, and Aug 15, 2017, 153 providers in the Z-CAN programme provided services to 21 124 women. 20 110 (95%) women received same-day provision of a reversible contraceptive method. Whereas only 767 (4%) women had used a LARC method before Z-CAN, 14 259 (68%) chose and received a LARC method at their initial visit. Of the women who received a LARC method, 10 808 (76%) women had used no method or a least effective method of contraception (ie, condoms or withdrawal) before their Z-CAN visit. Of the 3489 women who participated in a patient satisfaction survey, 3068 (93%) of 3294 women were very satisfied with the services received, and 3216 (93%) of 3478 women reported receiving the method that they were most interested in after receiving counselling. 2382 (78%) of 3040 women rated their care as excellent or very good.

Interpretation

Z-CAN was designed as a short-term response for rapid implementation of reversible contraceptive services in a complex emergency setting in Puerto Rico and has served more than 21 000 women. This model could be replicated or adapted as part of future emergency preparedness and response efforts.

During the current northern hemisphere's winter, seasonal influenza activity has become worrisome. According to the US Centers for Disease Control and Prevention (CDC), influenza activity is affecting the entire continental USA for the first time in 13 years and this year's season might well be severe. In the UK, in the first week of 2018, GP consultation rates for influenza rose 78%, and influenza-confirmed hospitalisations increased by 50% from the previous week, according to Public Health England.

Influenza A H3N2 and B viruses account for the majority of influenza globally, and it is know that the H3N2 virus mutates at a faster rate than other strains of the virus. The current influenza vaccines offer lower protection against influenza A H3N2 than other strains and, disturbingly, this season was marked by increased vaccination hesitancy among the public and even among health workers.

This unusual seasonal influenza outbreak is a wake up call to revisit influenza control strategies. More traditional public health precautions need to be reasserted. The CDC website explains several frequently forgotten or ignored everyday preventive actions that are aimed at limiting the spread of the disease. These include trying to avoid close contact with sick people, limiting contact with others while sick (by staying home for at least 24 hours after flu-like symptoms appear if needed), covering one's nose and mouth with a tissue while coughing or sneezing and throwing the tissue in the trash after use, keeping hands clean by regular washing with soap and water, avoiding touching mouth, nose, and eyes, and cleaning and disinfecting surfaces.

Influenza accounts for about 300 000 to 600 000 seasonal influenza-associated respiratory deaths annually. That systems are struggling to cope with seasonal influenza bodes poorly in the event of a virulent pandemic influenza, a century after the influenza pandemic of 1918.

Vaccination remains the most effective method for prevention and control of infection, but efforts from all health professionals to implement known influenza prevention strategies remain crucial to combat this persistent global health threat.

Through an agreement made between the governor and minister, up to 7.3 million paulistanos will be immunized in 53 municipalities

São Paulo will immediately receive 1 million doses of the vaccine to ensure the prevention of the disease and a supply of vaccine rooms before the beginning of the campaign against the disease, which will happen in February. The agreement was between Governor Geraldo Alckmin and Health Minister Ricardo Barros. Thus, in the state, the potential of people receiving immunization rises to 7.3 million in 53 counties, including the capital.

With the slogan "Information for all, vaccine for those who need it," the vaccination program of the Ministry of Health, in partnership with the states, aims to draw the population's attention to the importance of vaccination in places with a risk of transmitting the disease. In São Paulo, the action will be concentrated between February 3 and 24, when 6.3 million people will be vaccinated - 1.4 million will receive the standard dose and 4.9 million the fractional dose. Bahia and Rio de Janeiro will also participate in the measure between February 19 and March 9, when they should vaccinate 3.3 million and 10 million people, respectively.

In this month of January, states and municipalities will train health professionals and tailor the logistics to carry out the fractionation. To do this, the Ministry of Health must pass to the states R $54 million of the Variable Health Surveillance Floor, an extra resource to assist the states in the campaign. Of this total, R $15.8 million have already been transferred to São Paulo, and by the end of this month, R $30 million will be allocated to Rio de Janeiro and R $8.2 million to Bahia.

FRACTIONAL DOSAGE - Currently, the Ministry of Health uses the standard dose of the yellow fever vaccine, 0.5 mL. For the fractionated dose, 0.1 mL is used, which is 1/5 of the standard dose. A vial of 5 doses of the yellow fever vaccine, for example, can vaccinate 25 people and a vial with 10 doses can vaccinate 50 people.

A tsunami of sick people has swamped hospitals in many part of the country in recent weeks as a severe flu season has taken hold. In Rhode Island, hospitals diverted ambulances for a period because they were overcome with patients. In San Diego, a hospital erected a tent outside its emergency room to manage an influx of people with flu symptoms.

Wait times at scores of hospitals have gotten longer.

But if something as foreseeable as a flu season — albeit one that is pretty severe — is stretching health care to its limits, what does that tell us about the ability of hospitals to handle the next flu pandemic?

That question worries experts in the field of emergency preparedness, who warn that funding cuts for programs that help hospitals and public health departments plan for outbreaks and other large-scale events have eroded the very infrastructure society will need to help it weather these types of crises.

“There’s nothing really that can impact on a national level — or for that matter on an international level — more quickly than influenza,” warned Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

A dozen years ago or so, government officials placed pandemic influenza preparedness efforts on the front burner because of fears that a dangerous bird flu strain — spreading quickly across Asia at the time — might trigger a catastrophic pandemic.

Those worries were focused on H5N1, a poultry flu virus that infects few people but kills more than half of those confirmed to have been infected.

Then in 2009, the first flu pandemic in four decades did hit. But instead of bird flu, it was a swine flu virus called H1N1. There were not mass casualties. In fact, the global death toll was estimated at just over 200,000 — fewer people than the World Health Organization says die from seasonal influenza most years.

Pandemic influenza lost its big, bad bogeyman status. And in the years since, budgets for preparedness work have suffered.

“It’s true to some degree that we’re even more vulnerable now than we were at the time when H1N1 hit,” said Dr. Jeffrey Duchin, head of infectious diseases for the Seattle & King County public health department.

“We did learn a lot during the H1N1 outbreak about how to do things better,” Duchin noted. “But we haven’t invested in turning those learnings into action and better preparedness…. After H1N1, it’s pretty much fallen off the radar.”

Hospital and public health preparedness programs have sustained cuts in the order of about 30 percent in recent years, said Dr. Oscar Alleyne, a senior adviser with the National Association of County and City Health Officials, adding: “The level of funding is a concern to us.”

In the aftermath of the 9/11 attacks, Congress freed up money to help hospitals plan for and respond to mass casualty events, said Dr. Tom Inglesby, director of the Center for Health Security at Johns Hopkins University.

That has helped institutions respond to contained events — incidents like the Boston Marathon bombings or last year’s Las Vegas shooting, Inglesby noted. “But when you start scaling up beyond that and you introduce the variable of contagious disease, hospitals are pretty brittle,” he warned.

A booklet containing advice on how to cope with the outbreak of world war is set for a re-release after 30 years.

An updated version of the pamphlet Om kriget kommer (If War Comes) will be sent to Swedish homes in May or June, reports newspaper Aftonbladet.

First released in the 1940s during the Second World War, the booklet contains tips for citizens on what to do should Sweden become involved in a war.

The most recent version of the war advice book was produced in the 1980s. But with regional security considered to have worsened in recent years, and terrorism also having emerged, authorities have decided to re-issue the book with new content to reflect today’s national security circumstances.

“Back then the [booklet’s] focus was only on war. Today society looks completely different. There is a significantly more complex threat with climate change, terror attacks, pandemics and manipulation of information. People need to learn and know about how to deal with it,” Christina Andersson of the Swedish Civil Contingencies Agency (Myndigheten för samhällsskydd och beredskap, MSB), which has been commissioned by the government to produce the new version of the booklet, told Aftonbladet.

Meanwhile, a survey carried out by MSB found that Swedish public concern about the spread of nuclear weapons has increased significantly over the last year.

December 19, 2017

The National Institutes of Health (NIH) today lifted a 3-year moratorium on funding gain-of-function (GOF) research on potential pandemic viruses such as avian flu, SARS, and MERS, opening the door for certain types of research to resume.

The action coincides with today's release of a US Department of Health and Human Services (HHS) framework for guiding funding decisions about proposed research involving pathogens that have enhanced potential for creating pandemics.

Experts involved in the discussions welcomed the development, but some said the new framework still leaves key unanswered questions, such as how to responsibly report findings from the funded lab work in medical journals. Meanwhile, in research labs, some scientists plan to resume experiments and are relieved the pause has ended. Both groups are eager to see how the new review process works in real life.

In a statement today, NIH Director Francis Collins, MD, PhD, said "We have a responsibility to ensure that research with infectious agents is conducted responsibly, and that we consider the potential biosafety and biosecurity risks associated with such research." He added that he is confident that the review process spelled out in the new framework "will help to facilitate the safe, secure, and responsible conduct of this type of research in a manner that maximizes the benefits to public health."

Scientists gear up to resume studies

Research projects that were paused under the moratorium will now be reviewed based on the new framework, and the ones that clear the process will be able to proceed with appropriate risk mitigation measures in place.

Yoshihiro Kawaoka, DVM, PhD, who heads a virology research group at the University of Wisconsin-Madison, said his team will propose experiments they couldn't do during the funding pause. He was lead author of one of the two controversial H5N1 avian flu papers published in 2012 that brought the GOF controversy to a head.

"Specifically, we have been identifying amino acid changes that enhance the polymerase function of avian influenza viruses in mammalian cells to understand the molecular mechanism of avian-to-human transmission in a system not involving live virus," Kawaoka said. "We will now propose testing the effect of those amino acid changes on virus replication."

GOF research involves studies that enhance the pathogenicity, transmissibility, or host range of a pathogen to better understand the threat. However, GOF studies have sparked "dual-use" concerns that center around the threat of accidental lab release or the pathogens becoming bioterror threats if they fall into the wrong hands.

The latest EULabCap data [maps global index] on assessing the public health laboratory capacities among 30 EU and EEA countries in 2016 reveal continuous improvement in reducing inequalities, with ten more countries reaching fair to high capability levels over the 4 years of monitoring.

Data released today show that in 2016, areas of improved service capabilities across Europe included more robust infection diagnosis and antimicrobial susceptibility testing and wider contribution of reference laboratories to detect and respond to emerging and epidemic diseases and multidrug resistance threats.

While there have been significant improvements overall, there is still work to be done on Diagnostic testing utilisation which has not improved since the start of EULabCap survey. Another target which is not moving forward is EU wide capacity for Molecular Typing for surveillance. However a recent report showing the rapid expansion of European National Capacities for whole genome sequencing based typing, suggests that this limitation may soon be addressed by the ‘rapid transformation from molecular to genomic epidemiology.’

The Government tested its preparedness for possible detection of a novel influenza case today (November 30) during an exercise code-named "Garnet", organised by the Centre for Health Protection of the Department of Health (DH) in collaboration with other government departments and organisations at Wo Che Plaza, Sha Tin.

Exercise "Garnet" was aimed at assessing the interoperability of government departments and organisations in response to the detection of a case of novel influenza, testing their execution of the Preparedness Plan for Influenza Pandemic, as well as enhancing the alertness and readiness of relevant stakeholders in guarding Hong Kong against novel influenza and the threat of the spread of communicable disease.

About 50 participants from relevant government departments and organisations took part in the exercise, with 11 experts from the Mainland and Macau health authorities as observers. The exercise consisted of two parts. The first part was a table-top exercise conducted on November 15, in which relevant departments and organisations discussed and co-ordinated the communicable disease response measures required in the simulated scenario of detection of a confirmed case of novel influenza in Hong Kong.

The second part, conducted today, was a ground movement exercise. Under the exercise simulation, a female staff member of a telecommunications company working at Wo Che Plaza tested positive for novel influenza virus. Initial epidemiological investigations revealed that while she had no poultry contact locally, she had travelled to a country with a novel influenza outbreak. Among other staff members who had close contact with her, some had also developed symptoms of novel influenza.

The DH responded immediately and co-ordinated with relevant departments and organisations to formulate and implement corresponding measures. In addition to conducting on-site assessment and epidemiological investigations by its Public Health Team, the DH under this exercise also held a briefing for the staff members concerned, advised them on infection control measures, prescribed antiviral prophylaxis for the close contacts, and instructed the shopping mall operator and its cleaning services company to disinfect the contaminated areas.